1 Translated version of Genomsnit.. (1).doc The average general medicine specialist s work in Sweden A general medicine specialist s work in Sweden differs from most other EU countries in that it includes tasks that require a deeper knowledge of diagnostics and treatment of health problems in all ages. This means that the main body of people with the larger common diseases and health problems, including mental disorders, have been in medical contact solely with general practitioners. A further difference is that the district nurses and other professionals in Sweden perform duties that in some other EU countries are performed by doctors only. Another possibly distinctive approach to their daily work is the fact that Swedish patients expect participation and information to a greater extent than in some other EU countries. An average Swedish general medicine specialist s work includes giving priority on the basis of medical urgency. Switching between short acute visits, longer dialogues and home visits, and monitoring over a long period of time an individual's various health problems as well as assessing and taking into account the person's entire living situation. At general medicine clinics there is usually equipment for minor surgery and various types of examinations, which in many other countries is carried out in hospitals or specialist clinics. Adequate referral to other specialists is therefore only referrals for issues in which special equipment is required or in an unusual or difficult to treat condition, in which another specialist is necessary. For examples of referral practices see The work also includes basic child and maternal health care, preventive and rehabilitative work, administrative duties and writing various certificates. Medical liability for special residents (often for people with neurological damage or developmental disabilities), and nursing and care homes are common. The work is done in collaboration with other professionals, in co-operation with additional authorities and other agencies in the community. Training and supervision of medical students at all educational levels, from undergraduate to specialist training and with students in other health care professions is an important task. Swedish primary health care is today expected to apply knowledge-based care, which requires continuous ability development, where methods shown to be less effective are replaced with better ones. An important part of the general medicine specialist s work is systematic quality development and self-training based on their operations requirements. Some examples of common preventative tasks on the basis of subject area: Emergency care of critically ill or injured persons.
2 Diagnosis, treatment and, if necessary, appropriate referral of common health problems such as difficulty breathing, chest pain, abdominal pain, fever, infections, back pain, musculoskeletal symptoms, fainting, insomnia, fatigue, weight loss, dizziness, depression and anxiety and confusion. Childhood special health problems childhood common health problems childhood diseases childhood accidents Pediatrics (BVC) Blood and blood establishing organs anemias leukocytosis swollen lymph glands low blood pressure infection disorder hemorrhagic disorder thrombosis disorder Image Diagnostics, Laboratory Medicine and Clinical Physiology adequate orders on the basis of expected benefits, costs and available options interpretation and evaluation of the clinical significance of test results. Cardiovascular system deviation from normal blood pressure ischemic heart disease heart failure arrhythmias valvular disease and aortic diseases of the peripheral arteries and veins cerebral circulatory disorders DVT and pulmonary embolism Prevention of cardiovascular disorder The execution and interpretation of ECG, 24-hour blood pressure measurement and Doppler examination of peripheral blood vessels Endocrine System and Metabolism
3 diabetes mellitus metabolic syndrome disruption of thyroid function goiter dyslipidemia disorder of the adrenal, parathyroid and pituitary-function osteoporosis porphyria, hyperuricemia, pheochromocytoma The skin itching rash acne and rosacea infections, infestations and bites allergic reactions chronic wounds pigment changes chronic skin diseases malignant transformation hair and nail disorders Removal of birthmarks, and superficial tumors like lipoma and atheroma Surgical treatment of ingrown toenails Punch biopsy Pharmacology: adjustment of drug therapy to the individual's medical needs and national and regional recommendations optimization of antibiotic usage based on the individual and society s needs. initiation and monitoring of drug therapy for most chronic diseases such as hypertension, asthma and psoriasis discontinuation of treatment when the indication has ceased to exist evaluation and optimization of multi-pharmacological treatment of complex medical conditions, or where multiple caregivers are involved therapy control, for example - anticoagulant therapy with Waran Infections viral and bacterial infections of the respiratory tract investigation of the frequent cases of disease in families, in nursery schools or community shingles and the resulting pain problems Borrelia
4 gastro-intestinal infections sexually transmitted diseases (including contact tracing) Female genital organs and breasts gynecological disorders and diseases in women of different ages reduced libido breast lumps sexually transmitted diseases (including contact tracing) Smear sample-testing Contraception Advice Basic reproductive health Lungs and airways nasal congestion and haemorrhage cough and hoarseness snoring and sleep apnea respiratory infections allergic reactions asthma and acute treatment COPD The execution and interpretation of spirometry Male genitalia skin-transformation of the penis and foreskin problems inflammation of the testis and epididymis hernia and testicular retention sexually transmitted diseases (including contact tracing) impotence and erectile dysfunction prostate problems injuries Contraception Advice Digestive absorption state and food intolerance dyspepsia, gastroesophageal reflux disorder, peptic ulcer diseases of the biliary tract, liver and pancreas discomfort, and disease, intestinal gastroenteritis parasitic diseases
5 malignant diseases Procto /rectoscope Musculoskeletal pain and suffering in neck, back, shoulders or other joints pain in the tendon or muscle rheumatic diseases arthritis osteoarthritis acute injury overload condition birth defects and transformations residual condition after polio Joint puncture and injection. Nervous system symptoms of the nervous system e.g. headaches, seizures, palsies, abnormal sensations and dizziness Dementia other neurological diseases such as MS, Parkinson's disease, epilepsy, infections and tumors headache chronic pain and neuralgias concern for brain tumor Renal and urinary disorders cystitis and other infections urination discomfort urinary incontinence outflow obstruction and stone disease renal impairment Mental health and behavioral problems anxiety and apprehension sadness, depression somatization disorder insomnia crisis reaction personality disorder confusion and dementia
6 delusions and hallucinations eating disorders post-traumatic stress disorder Assessment of suicide risk Hazardous-use, misuse and problematic living Preventive measures, diagnosis and treatment against the abuse of alcohol, tobacco, medicines and drugs Smoking Cessation Issuance of certificate and authoritative administration Collaboration with social services Rehabilitation Identification of rehabilitation needs Cooperation with physiotherapists, occupational and social insurance, etc. Issue of certificates for social security, employment, etc.. Injuries and accidents acute assessment and treatment of major injuries before transport suturing of minor wounds assessment, treatment and, if necessary, adequate referral: acute injuries of the musculoskeletal system different types of occlusal damage poisoning thermic damage damage caused by foreign body or caustic substances anoxic injury Palliative Care palliative treatment interaction with relatives coordination of care initiatives The eye red eye eyelid diseases eye injuries, such as removal of foreign body and treatment of glare trauma in the eye region eye influence in systemic diseases Assessment of visual impairment Ear
7 Diagnosis, treatment and any time of referral: infections and inflammatory conditions nosebleeds ear induced dizziness injuries and foreign bodies tinnitus Assessment of hearing loss November Eva Jaktlund President SFAM sfam.se